Chronic Respiratory Disease最新文献

ObjectivesTo determine the feasibility and acceptability of home-based pulmonary rehabilitation (HBPR) for individuals with idiopathic pulmonary fibrosis (IPF).MethodsIn this single-arm feasibility trial, individuals with IPF were recruited from Delhi, India, to a 6-weeks HBPR programme using a paper-based manual. Primary outcomes were feasibility (classified by ≥60% of eligible patients recruited and ≥70% of recruited patients completing the follow-up assessment) and intervention acceptability (semi-structured interviews).ResultsOut of 42 screened, 36 individuals were eligible (86% of screened), and 30 were recruited (83% of eligible, 71% of screened; 60 ± 13 years, 53% female), with 25 completing their follow-up assessment (83% of recruited). HBPR was generally well-accepted, with qualitative themes including: 'facilitators and barriers to HBPR' (family support and flexibility of home environment were facilitators whereas lack of supervision and inability to follow a routine were barriers), 'perceived changes from taking part in HBPR' (improved exercise capacity, breathlessness, and independency), and 'how to improve HBPR in the future' (translating the manual into various languages, and incorporating into a more hybrid approach).ConclusionHBPR using a paper-based manual was feasible and acceptable, potentially suitable for improving the uptake and completion of PR for individuals with IPF in Delhi, India.

ObjectiveConnective tissue disease (CTD) encompasses a group of autoimmune disorders, with interstitial lung disease (ILD) being the most common form of pulmonary involvement. The primary focus of this study was to employ machine learning for the identification of blood-based biomarkers in individuals afflicted with CTD-ILD. Additionally, the study aimed to assess the potential association of these biomarkers with the likelihood of hospital readmissions and all-cause mortality within a 1-year period among CTD-ILD patients.MethodsA total of 210 patients were included in the study, with 147 patients allocated to the training set and 63 patients assigned to the test set. Univariate logistic regression, LASSO regression, and multivariable logistic regression analyses were executed to discern the risk factors associated with readmission within 1 year among CTD-ILD. Logistic regression, support vector machine, and XGBoost were utilized to build the model. The global and local interpretation of the model was conducted using SHAP. The efficacy of model was evaluated using the ROC curve and DCA. Furthermore, the predictive values of inflammatory indicators were compared for their ability to forecast all-cause mortality in CTD-ILD patients.ResultsLow albumin levels, high CA125, and CYFRA 21-1 were identified as significant factors associated with patient readmissions. The XGBoost model demonstrated the highest efficacy in both the training and test sets, achieving an AUC of 0.857 (95% CI 0.832-0.879) and 0.788 (95% CI 0.706-0.833), respectively. SHAP analysis indicated that low albumin had the most significant impact on the model outcomes. Among the 1-year all-cause deaths of CTD-ILD patients, the neutrophil-to-lymphocyte ratio (NLR) was the most potent predictor in univariate analysis. A model combining albumin, CA125, and CYFRA 21-1 with NLR was constructed, achieving an AUC of 0.944 (95% CI 0.915-0.964).ConclusionElevated levels of CA125, CYFRA 21-1, and NLR, along with lower albumin levels, were predictive of a poor prognosis in CTD-ILD patients.

BackgroundBreathlessness is a common and distressing symptom across a wide range of medical conditions. Different aspects (dimensions) of breathlessness can be assessed using the Multidimensional Dyspnoea Profile (MDP) and Dyspnoea-12 (D12) questionnaires. We aimed to examine whether the order of completing MDP and D12 affects the breathlessness responses in people with cardiorespiratory disease.MethodsThis was a randomised controlled trial embedded within a longitudinal clinical study. Outpatients with cardiorespiratory disease were randomly assigned to either first complete the MDP or the D12. Primary outcome was mean difference in D12 total score between groups, secondary outcome was mean difference in D12 and MDP subdomain scores. Both outcomes were compared to the minimal clinically important difference (MCID) for each scale.ResultsAll 182 participants from the longitudinal study were included. 93 were randomized to complete MDP first and 89 to D12 first. Characteristics such as age, sex, main cause of breathlessness and smoking status were similar between groups. The mean difference for D12 total score (MCID = 2.8) was -1.5 (-4.2 to 1.3, p = 0.26) between groups. Mean differences between groups in subdomain scores were also below the corresponding MCID.ConclusionThe order of completion of MDP and D12 did not impact the scores significantly, but the study lacked power to find smaller yet clinically significant differences. The study supports that the most practical order of completing the instruments can be used in future research and in clinical settings.

BackgroundChronic obstructive pulmonary disease (COPD) is associated with alterations in brain function that contribute to reduced respiratory and skeletal muscle strength, ultimately limiting exercise capacity. Transcranial direct current stimulation (tDCS), a non-invasive neuromodulation technique, has demonstrated efficacy in enhancing lower extremity function in healthy older adults.ObjectiveTo evaluate the effects of a single session of anodal tDCS on exercise capacity, respiratory muscle strength, and physical performance in individuals with COPD.MethodsIn a randomized, double-blind, sham-controlled trial, 26 participants with COPD underwent baseline assessments of exercise capacity (Six-Minute Walk Distance, 6MWD), respiratory muscle strength (Maximum Inspiratory Pressure, MIP), and physical performance (4-m Gait Speed, 4MGS). Participants then received either active or sham tDCS, followed by reassessment 1 day post-intervention.ResultsCompared to sham, the active tDCS group showed significant improvements in physical performance, including increases of 46 ± 11.45 m in 6MWD (p < 0.001), 12.54 ± 4.52 cm, H₂O in MIP (p < 0.01), and 0.24 ± 0.08 m/s in 4MGS (p < 0.05).ConclusionA single session of anodal tDCS may enhance exercise capacity, inspiratory muscle strength, and gait speed in patients with COPD, suggesting its potential as a supportive intervention in pulmonary rehabilitation.

Excessive dynamic airway collapse (EDAC) is characterized by abnormal airway collapse during expiration, leading to symptoms such as breathlessness, cough, and reduced quality of life. Treatment options remain limited, and evidence-based guidelines are lacking. This prospective cohort study evaluated the impact of positive airway pressure (PAP) therapy on symptom burden in 23 patients with EDAC referred to a tertiary ventilation centre. Diagnosis was confirmed by computed tomography and/or bronchoscopy. Patients received nocturnal and ambulatory PAP, with symptom ratings and quality of life assessed at baseline and after three months. PAP therapy produced rapid and sustained improvements in breathlessness, orthopnoea, cough frequency, sleep quality, and quality of life, with significant differences in all domains (p < 0.01). Adherence to nocturnal PAP was high. These findings suggest that PAP therapy is an effective symptomatic intervention in EDAC and support consideration of EDAC as an indication for PAP therapy in future clinical guidelines.

Background: Almost 20% of Polish citizens aged >15 years are obese and this number is increasing. Numerous obesity-associated diseases include, quite notably, also sleep-related breathing disorders and hypoventilation. This study aimed to analyse the prevalence of obesity hypoventilation syndrome (OHS) and hypoventilation staging in a group of patients qualified for bariatric surgery within the Comprehensive Specialist Care in Bariatrics (KOS-BAR) pilot program designed and running in Poland since 2021. Methods: Prior to the bariatric procedure, the participants were referred to a pulmonologist for assessment. We retrospectively analysed the records of 134 patients. Results: Almost all of the tested bariatric patients (n = 122, 91.0%) had obstructive sleep apnea mainly classified as severe (59.0%). Hypoventilation was confirmed in 30 patients (22.4%), and in 37.9% of them, increased levels of serum bicarbonate were found. Chronic diurnal hypercapnia was confirmed in 7.9% of patients (10/122). Conclusions: Hypoventilation as well as obstructive sleep apnea in the obese population is a significant issue. The presented study group included patients in stages 0-IV of obesity-associated hypoventilation. The conducted analysis suggests that the most common form of hypoventilation among patients qualified for bariatric surgery is obesity-associated sleep hypoventilation (stage I).

BackgroundCentre-PR may not be accessible for people living distant from PR centres. Remote digital PR may have equivalent benefits to centre-PR; however, previous trials were potentially biased towards digitally literate patients, and largely excluded participants with a preference for centre-PR. There is limited data on the real-world implementation of, and acceptability for, Digital-PR alone or as an adjunct to other models of PR.ObjectivesTo gather patients' views about the acceptability of Active+me REMOTE, a digital pulmonary rehabilitation app (Digital-PR).MethodsA qualitative exploratory study using semi-structured interviews with a subset (n = 15) of patients in a mixed method, feasibility study of a hybrid pulmonary rehabilitation, blending Digital-PR with other models of PR. Transcribed data were coded descriptively using Braun and Clarkes' methodology, data interpretation was facilitated through a Miro virtual whiteboard.ResultsThere was appreciation for the concept of Digital-PR, indicated by positive responses in the domains of "friends and family recommendation," "intention to continue using the app," and "privacy concerns." Benefits were reported by two participants who had declined centre-based PR. The app was rated low regarding user-friendliness. Challenges in understanding/using the app and a perception of challenges for others were reported and were associated with poor digital literacy and tech savviness. High digital skills did not predict a favourable assessment of the app as user-friendly.DiscussionWhilst there was a general appreciation for the concept of digital PR as an adjunct or alternative to traditional centre-based PR, the app did not appear to be user-friendly, nor acceptable to people with low digital literacy. The findings have implications for the wider routine implementation of Digital-PR.

BackgroundFrailty is common among patients referred to pulmonary rehabilitation (PR) programs. While it is considered an independent predictor of program non-completion, people with frailty respond positively to PR. Clinicians' perspectives on assessing and managing frailty in PR has not been established. This study aimed to identify clinicians' current practices, perceptions, and opinions on assessing and managing frailty in people who attend PR in Australia and New Zealand.MethodsAn international online survey targeting healthcare professionals in Australia and New Zealand involved in PR programs using a combination of multiple-response closed-ended and open-ended questions. This survey study was reported in accordance with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS).ResultsOf 103 responses, 89 healthcare professionals completed the survey (92.6% completion rate). Nineteen percent routinely assessed frailty, mostly using Short Physical Performance Battery (SPPB). Respondents reported the main considerations for choice of frailty assessment tools were ease of use and cost. The most common frailty indicators identified by respondents included falls history, low body weight, slow or aided gait, and muscle weakness. Seventy-nine percent believed PR to be appropriate to manage frailty in this population, while 94% desired additional resources in future guidelines. Suggestions to improve PR to better manage frailty included reshaping rehabilitation program content, and providing specific patient education. Future desired research priorities included improvements to frailty assessment tools, frailty-specific guidelines and workforce training.ConclusionThis study explores PR practices among clinicians in Australia and New Zealand, showing variability in frailty assessment and management. It provides a foundation for evaluating key aspects of PR models that can be tailored to these clients' needs and limitations.

The aim of this study is to evaluate the correlations of peak oxygen uptake (VO2peak) with lung mechanics, radiographic abnormalities, and quality of life (QoL) in adults with post-tuberculosis lung disease (PTLD). This is a cross-sectional study in which 60 adults with PTLD underwent a cardiopulmonary exercise test (CPET). Additionally, the following assessments were performed: spirometry, impulse oscillometry (IOS), chest X-ray (CXR), and QoL using the WHOQOL-BREF. The mean peak oxygen uptake (VO_2peak) was 16.1 ± 6.8 ml/kg/min. There were positive correlations between VO_2peak and several parameters, including height, physical-WHOQOL-BREF, and forced vital capacity (FVC). There were negative correlations between VO_2peak and several parameters, including age, heterogeneity of resistance between 5 and 20 Hz, frequency response (Fres), and reactance-area. In IOS, patients with small airway disease (SAD) had a lower VO_2peak. Regarding CXR, only cavitation and nodular opacities were associated with a lower VO_2peak. In multivariate analysis, FVC, age, male sex, and Fres explained 65.2% of the variability in VO_2peak. In conclusion, there is a relationship between VO_2peak and lung mechanics in patients with PTLD. In these patients, IOS is able to detect more pulmonary mechanical alterations than spirometry, including those reflecting SAD. Thus, the use of both CPET and IOS may aid in the monitoring of patients with PTLD.

IntroductionCurrent research mainly examines the link between sarcopenia and obstructive spirometry, with limited studies on preserved ratio impaired lung function (PRISm). This study aims to investigate the association between skeletal muscle index (SMI) and lung function indicators in populations with different characteristics, with particular emphasis on the PRISm population.MethodsData were utilized from the National Health and Nutrition Examination Survey (NHANES) 2011-2012 cycle. The participants were categorized into three groups: obstructive spirometry, PRISm, and normal spirometry. The SMI was calculated by dividing appendicular skeletal muscle mass by body mass index. Multiple linear regression analysis was employed to explore the relationship between the SMI and lung function indicators, including forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC).ResultsAmong the 2513 participants aged 20-59 years, 2096 had normal spirometry, 186 were in the obstructive spirometry group, and 231 were in the PRISm group. The SMI was significantly associated with lung function indicators after adujustment: in the obstructive spirometry group, per 0.1 unit increase in SMI was linked to an increase in FEV1 of 0.214 L (95% CI: 0.115-0.313, p < 0.001) and in FVC of 0.339 L (95% CI: 0.213-0.465, p < 0.001); in the PRISm group, per 0.1 unit increase in SMI was associated with an increase in FEV1 of 0.184 L (95% CI: 0.149-0.219, p < 0.001) and in FVC of 0.222 L (95% CI: 0.169-0.274, p < 0.001); and in the normal spirometry group, per 0.1 unit increase in SMI was linked to an increase in FEV1 of 0.240 L (95% CI: 0.222-0.257, p < 0.001) and in FVC of 0.316 L (95% CI: 0.294-0.338, p < 0.001).ConclusionOur study newly identifies a significant positive association between SMI and lung function in the PRISm group, a relationship also consistently observed in obstructive and normal spirometry groups.